Resumen

MLOTSHWA, N W et al. An audit of extracorporeal membrane oxygenation outcomes in patients with low cardiac output syndrome at Charlotte Maxeke Johannesburg Academic Hospital, South Africa. SAMJ, S. Afr. med. j. [online]. 2025, vol.115, n.6, pp.39-44. ISSN 2078-5135.  https://doi.org/10.7196/SAMJ.2025.v115i6.2341.

BACKGROUND. Extracorporeal membrane oxygenation (ECMO) is a means of supporting an inefficient cardiorespiratory system, refractory to medical treatment, with a mechanical device. Low cardiac output syndrome (LCOS) is a frequent problem after cardiopulmonary bypass. Globally, centres have investigated outcomes of ECMO and have documented associated preoperative, intraoperative and postoperative predictive factors. Our centre has used ECMO since the mid-1990s, but there has been no study investigating the outcomes. OBJECTIVES. To evaluate 30-day survival and associated predictive factors among patients with LCOS in whom ECMO was used during or after open-heart surgery. METHODS. The study was a retrospective review of clinical records of adult patients in whom ECMO was used during or within 72 hours after open-heart surgery from November 2016 until the end of December 2022. Data were collected using the RedCap (Research Electronic Data Capture) online database manager at the University of the Witwatersrand and entered into a Microsoft Excel spreadsheet. For descriptive analysis, continuous data were analysed using a one-way analysis of variance. The association between patient factors and outcomes was analysed using Fisher's exact test. Statistical analysis was conducted using Stata. RESULTS. ECMO was used in 4.6% (n=60) of 1 311 patients who underwent heart surgery during the study period, of whom 38 met the study selection criteria; of these, 6 (15.8%) survived to discharge. Of the patients who survived, 5 were black females in the working age group. All the patients who died (n=32/38; 84.2%) did so within 30 days. All the patients experienced morbidity while on ECMO. All the surviving patients survived for >30 days and were discharged from hospital. CONCLUSION. Our ECMO survival rate following open heart surgery (~16%) is low compared with other better-established centres. Various factors were associated with the poor outcomes.

Palabras clave : Charlotte Maxeke Johannesburg Academic Hospital; South Africa; extracorporeal membrane oxygenation; ECMO; post-cardiotomy; outcomes; cardiothoracic surgery.

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